| NPI | 1376015610 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY CLOYD Secretary 904-605-4986 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral |
| Enumeration Date | 2018-12-27 |
| Last Update Date | 2023-07-25 |